| dc.description.abstract | This research includes three parts. In the first part, we give the general idea of the background of the hospital industry in Taiwan after the practice of NHI. Since multihospital system paly an important role in this industry, we analyze the impacts of multihospital system on medical service quality in our second part and on the production technical efficiency in our third part, respectively.
In the first part, we find that the scale of hospital is getting larger, which is resulted from (1) the payment from Bureau of National Health Insurance based on Hospital Accreditation; (2) insurants’ medical behavior after the practice of NHI; (3) foundation hospital appearance with tax reduction. The development of large scaling hospital could distort the efficiency of resource allocation and cause the breakdown of division of hospital work. Furthermore, the multihospital system is also a key point of large scaling hospital. Although the multihospital system only takes 29% of the total number of the hospital in Taiwan, it takes 60% of the total hospital bed. Thus, we analyze the medical service quality and the production technical efficiency in multihospital system in part 2 and 3.
In the second part, we study the effects of multihospital system on medical service quality. Based on the theoretical model (Gaynor 2006), we find that the multihospital system has the advantage of economic scale and cost-saving. The reduction of marginal cost helps the improvement of medical service quality. However, when it faces a less competitive market, the multihospital system might slack off in medical service, which increases the marginal cost of enhancing medical quality and decreases the medical service quality. The empirical results show that the operation of multihospital system helps to improve the medical service quality.
In the third part, we adopt the metafrontier framework estimated with DEA (O’Donnell et al. 2008) to analyze the effects of multihospital system on technical efficiency. We also examine whether the multihospital system can help hospitals reach the technological level of metafrontier and improve the technical change. Our empirical results show that multihospital system does not have a significant effect on technical efficiency. However, after the practice of global budget system, the multihospital system of the local hospitals can improve technical efficiency. Under the analysis of metafrontier, we find that multihospital helps hospitals approach their potential production technological level. In addition, multihospital system has no significant effect on technological change. After the practice of global budget system, however, multihospital system can improve technology.
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